US9023062B2 - Implantable access port device and attachment system - Google Patents

Abstract

A system for attaching an access port to bodily tissue includes an access port assembly and including an access port having a generally central axis. The access port assembly further includes an attachment mechanism structured to enable the access port to be attached, for example, to an abdominal muscle of a patient. The delivery tool includes a handle having a generally longitudinal axis and a delivery head structured to engage the access port assembly, and an activation mechanism for enabling deployment of the attachment mechanism when the delivery head is so engaged with the access port assembly. The delivery tool is configured such that the longitudinal axis of the handle is spaced apart from the generally central axis of the access port when the delivery head is so engaged with the access port assembly.

Description

RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application No. 61/045,890 filed on Apr. 17, 2008, the entire disclosure of which is incorporated herein by this specific reference.

BACKGROUND

The present invention generally relates to medical implants and more specifically relates to an implantable access port device and an attachment mechanism for attaching such an access port device to tissue.

Medical implants for performing therapeutic functions for a patient are well known. Such devices include pace makers, vascular access ports, injection ports (such as used with gastric banding systems) and gastric pacing devices. Such implants need to be attached, typically subcutaneously, in an appropriate place in order to function properly. It is desirable that the procedure to implant such devices be quick, easy and efficient and require as small of an incision as possible.

SUMMARY OF THE INVENTION

The present invention is directed to a system including an implantable access port, for example, but not limited to, an implantable access port for use in inflating and deflating an inflatable a gastric band. Generally, the system includes an access port configured to be connected, for example, by means of a fluid conduit, to an inflatable portion of a gastric band. Access ports for use with gastric bands are well known and are described, for example, in U.S. patent application Ser. No. 10/562,964 filed on Sep. 15, 2004; U.S. patent application Ser. No. 10/562,954 filed on Jan. 21, 2005; Ser. No. 11/472,902 filed on Jun. 22, 2006; U.S. patent application Ser. No. 11/444,702, filed on May 31, 2006 and U.S. patent application Ser. No. 11/540,177, filed on Sep. 29, 2006, the entire disclosure of each of these patent applications being incorporated herein by this specific reference.

In one aspect of the invention, a system for attaching an access port to bodily tissue is provided.

The system generally comprises an access port assembly including an access port and an access port housing generally containing the access port. The access port may be structured for holding, receiving and enabling passage of a fluid between the access port assembly and a patient or into another implanted device in a patient, for example, a gastric band.

For example, the access port includes a bottom, a sidewall and a needle penetratable septum. The needle penetratable septum is spaced apart from the bottom and lies in a plane approximately parallel therewith. The sidewall, bottom and septum define a space for holding fluid. The access port assembly has a generally central axis extending through the bottom, the septum and the space for holding fluid. The sidewall generally surrounds this axis and is radially spaced therefrom.

The access port assembly further includes an attachment mechanism, including, for example, a plurality of rotatable anchors having a deployed position and an undeployed position. When in the deployed position, the anchors fix the access port to bodily tissue. In the case where the system is used in conjunction with a gastric band, the access port assembly may be secured, by means of the anchors, to the rectus muscle fascia.

In some embodiments, the attachment mechanism is reversible, allowing the implantable medical device to be detached from tissue.

In a specific embodiment, each of the anchors is made of wire, for example, a bent, stainless steel wire having round cross section and a multi-faceted, sharp distal tip.

In one embodiment, the plurality of anchors comprises four anchors spaced apart about the access port. Each anchor includes a curved distal portion which engages tissue and a pivotal proximal portion which is rotatably connected to the access port housing. In some embodiments, the pivotal proximal portion is substantially perpendicular with the curved distal portion, or more specifically, substantially perpendicular with a plane in which the curved distal portion rotates when the anchors are moved into the deployed position. In some embodiments, each anchor may include a generally spiral distal portion and a straight proximal portion substantially perpendicular with the spiral distal portion. A cam system may be used as a means for actuating deployment of the anchors, for example, upon rotation of a rotating activator of the access port housing.

In another aspect of the invention, the system further comprises a delivery tool structured to facilitate attachment of the access port assembly to bodily tissue. The tool includes a handle having a generally longitudinal axis and a distal portion structured to couple with or engage the access port assembly. The tool further includes an activation mechanism for activating deployment of the attachment mechanism. In some embodiments, the tool is configured such that the generally longitudinal axis of the handle is spaced apart from the generally central axis of the access port when the delivery tool is so engaged with the access port assembly. For example, the delivery head of the tool is offset from the tool handle. For example, the tool has a generally, non-linear, or curved, configuration with the delivery head being located forward of, or extending away from, the handle.

In another aspect of the invention, the activation mechanism of the tool comprises a cable mechanism, for example, two cables extending from a proximal end of the tool along the tool handle to the delivery head. In a specific embodiment, the cable mechanism comprises two opposingly movable cables. Longitudinal displacement of the cable mechanism causes rotational movement of the anchors when the tool is engaged to the access port assembly. The cables may be made of tungsten, or a tungsten material. Generally, each cable includes a substantially straight proximal portion extending along the handle of the tool and a curved distal portion connected to a rotating element of the delivery head.

Each and every feature described herein, and each and every combination of two or more of such features, is included within the scope of the present invention provided that the features included in such a combination are not mutually inconsistent.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may be better understood with reference to the following Detailed Description and Drawings of which:

FIG. 1 is a simplified perspective view of an access port assembly of a system of the invention as implanted in a patient and being used for inflation and deflation of a conventional gastric band for treating obesity;

FIGS. 2 and 3 are perspective views of a conventional gastric band useful in conjunction with the system of the present invention, the gastric band being shown in a deflated state and an inflated state, respectively;

FIG. 4 is a perspective view of a system in accordance with the present invention, including an access port assembly and a delivery tool for applying the access port assembly to bodily tissue;

FIG. 5 is a perspective view of the access port assembly and a delivery head of the tool separated from the access port assembly, of the system shown inFIG. 4;

FIG. 6 is an exploded view of the access port assembly shown inFIG. 5;

FIG. 6A is a cross-sectional view of the access port assembly coupled with the delivery head;

FIG. 7 is a partial cross-sectional side view of the system shown inFIG. 4;

FIGS. 8A and 8B are cross-sectional side views of the proximal portion of the tool showing an activation mechanism in an unlocked state and a locked state, respectively;

FIG. 9 is a side view of the distal portion of the tool.

FIG. 10 is a cross-sectional view of the distal portion of the tool and the access port assembly of the system of the invention;

FIGS. 11,12 and13 show a cut-away view of the access port with an anchor thereof in an undeployed state, a partially deployed state and a fully deployed state, respectively;

FIG. 14 shows a cross-sectional view of a top of the tool taken along line14-14 ofFIG. 12;

FIG. 15 is a cross-sectional view taken along lines15-15 ofFIG. 13;

FIG. 16 is a cross-sectional view taken along lines16-16 ofFIG. 14; and

FIG. 17 is a cross-sectional view taken along lines17-17 ofFIG. 15.

DETAILED DESCRIPTION

Turning now toFIG. 1, a simplified perspective view of anaccess port assembly10 of a system of the invention is shown. Theaccess port assembly10 is shown as it is being penetrated by a needle2 of a manually operable syringe3. By passing fluid into theaccess port assembly10, or removing fluid by means of theaccess port assembly10, as will be described in greater detail hereinafter, the needle2 and syringe3 provide a convenient means for inflating and/or deflating a conventionalgastric band4, thereby enabling adjustment of a size of a stoma or a level of restriction on a patient'sstomach5. The gastric band3 is shown in a deflated state inFIG. 2 and an inflated state inFIG. 3, and is not considered, in itself, to make up an embodiment of the present invention.

Turning now toFIG. 4, asystem20 in accordance with one embodiment of the invention is shown. Thesystem20 generally includes an implantableaccess port assembly10 and atool30 for fixing theaccess port assembly10 to bodily tissue. Theaccess port assembly10 is configured to be connected, for example, by means of a fluid line6 (seeFIG. 1) to an inflatable portion of agastric band4.

Referring now toFIG. 5, theaccess port assembly10 generally comprises anaccess port34 having aseptum36, a chamber37 (shown inFIG. 6A) and an inlet/outlet connector38 in communication with thechamber37. Theaccess port34 is structured for holding, receiving and enabling passage of a fluid between inlet/outlet connector38 and fluid line6.

In the shown embodiment, theaccess port assembly10 includes accommodations for facilitating suturing thereof to the patient, in the event that the use of thetool30 to attach theaccess port assembly10 is not desired. For example, suturing holes40 are provided.Needle clearance regions41 may also be provided to facilitate suturing.

Theaccess port assembly10 is shown in detail inFIGS. 6 and 6A. Theaccess port34 includes an access port bottom42, a substantially cylindricalaccess port sidewall44 and needlepenetratable septum36. Theaccess port34 further includes passage for example,outlet barb48, extending fromchamber37, which makes up a part of an inlet/outlet connector38 coupleable to fluid line6.

Inlet/outlet connector38 may comprise astrain relief element50 which locks into acoupler51 ofhousing sidewall56 and protects fluid line6 from folding, kinking, rotating or torquing where line6 connects to theaccess port assembly10. Further strain relief may be provided byflexible sleeve51a.Flexible sleeve51amay be made of a puncture-resistant material, and, along withstrain relief element50, provides protection against accidental needle puncture to line6.

Theseptum36 is spaced apart from theaccess port bottom42 and lies in a plane approximately parallel therewith.Septum36 may be made of any suitable needle penetratable material, for example—a self sealing, needle penetratable material. Theaccess port sidewall44,access port bottom42 andseptum36 define achamber37, or space, for holding fluid. Theaccess port bottom42 andaccess port sidewall44 may be integral components of a substantially unitary structure made of a biocompatible metallic material, for example, titanium.Outlet barb48 may also be made of the same material.

Theaccess port assembly10 has a generally central axis, indicated byline52 inFIG. 6, extending through the access port bottom42, theseptum36 and thechamber37. Theaccess port sidewall44 generally surrounds the generallycentral axis52 and is radially spaced apart therefrom. It should be appreciated that when theaccess port assembly10 is implanted for use in a patient, the generallycentral axis52 is generally perpendicular to the surface of the tissue or muscle to which the access port assembly is attached.

Theaccess port assembly10 further includes ahousing54 including ahousing sidewall56 substantially surrounding theaccess port sidewall44, and an actuator assembly. Actuator assembly is made up of anactuator cap58 andactuator element62 which are rotatable (as indicated byarrows64 on actuator cap and actuator element62) with respect to thehousing sidewall56. Thehousing54 further includes ananchor base66 includingtracks68 for receivingactuator element62.

Theaccess port assembly10 further includes anattachment mechanism70. Theattachment mechanism70 is structured to anchor or fix theaccess port assembly10 to the patient. Theattachment mechanism70 may comprise, for example, a plurality ofrotatable anchors74 which are movable between an undeployed position and a deployed position.

In the shown embodiment, the plurality of rotatable anchors74 comprises four anchors74. Theanchors74 are generally spaced apart for example, substantially equidistantly spaced apart, about a circumference of theaccess port34. When in the undeployed position, theanchors74 are substantially concealed and contained between theactuator element62 and thehousing sidewall56. During deployment, theanchors74 rotate and travel out of their contained, substantially concealed position to an exposed position, by sliding throughapertures75 inanchor base66.

Eachanchor74 may be made of a wire, for example, stainless steel wire. Theanchor74 may comprise a bent wire having a generally round cross-section and a sharpdistal tip76.

Theanchor tip76 is structured to penetrate and enter bodily tissue as theanchor74 rotates into the deployed position. In some embodiments, theanchor tip76 includes one or more flat faces. For example, thetip76 may have a single facet, or may be multi-faceted. For example, thetip76 may have two facets or three or more facets.

In a specific embodiment, theanchors74 are a bent stainless steel wire have a generally arc shape having an arc diameter of slightly less than about 0.5 inch and a constant circular cross section of about 0.023 inch diameter.

Eachanchor74 includes a curveddistal portion80 which engages tissue and a pivotal proximal portion82 which is rotatably connected to theanchor base66 of the port housing. In the shown embodiment, the pivotal proximal portion82 is substantially perpendicular with the curved or spiraldistal portion80, or more specifically, substantially perpendicular with a plane in which the curved distal portion moves when theanchors74 are rotated into the deployed position.

Turning briefly toFIG. 4, theaccess port assembly10 may further comprise aremovable safety cap83 to protect a physician's or medical personnel's hands and fingers from accidental anchor sticks. Thesafety cap83 mounts to the bottom of theaccess port housing54 by a press-on fit. The color of thesafety cap83 may be an easily distinguishable from the port housing color.

Referring back now toFIG. 6, theaccess port assembly10 may include one ormore locator elements84, for example, at least one or two or more radioopaque markers86 that are clearly visible under an x-ray. These may be secured inport housing54 and spaced apart from theaccess port34 so as not to hide the marker image with an image of theaccess port34. In a specific embodiment, twomarkers86 are provided, each having dimensions of about Ø0.075″×0.200″ in length a separation distance from theaccess port34 of at least about 0.100″ in. The markers can be used to facilitate identification of the type of gastric band or other useful information to be identified by an X-ray image of theaccess port assembly10, for example, by using varied configurations ofmarkers86.

As shown inFIG. 7, thetool30 includes ahandle90 having a generally longitudinal axis (indicated by line92) and adistal portion96 structured to be removably and functionally coupled to theaccess port assembly10.

In the shown embodiment, thetool30 is configured such that the generally longitudinal axis of thehandle90 is spaced apart from, or not aligned with, the generallycentral axis52 of theaccess port34 when thetool30 is coupled with theaccess port assembly10. In other words, thedelivery head96 of thetool30 which engages theaccess port assembly10 is offset from thetool handle90, i.e., the portion of thetool30 that is handled by an operator thereof. In some embodiments, the generally central axis of theaccess port34 and the longitudinal axis of the handle are offset a distance of at least about one inch to about two inches or more.

For example, thetool30 has a generally curved, scoop shaped, L-shaped, or similar “offset” configuration such that thedelivery head96 is located forward with respect to, or extending away from, thehandle90. This configuration enables thetool30 to be used to implant theaccess port assembly10 using a relatively small incision for example, in comparison to a conventional applier or tool that is substantially unilinear in configuration, or requires the tool to be substantially entirely aligned with a central axis of a similarly sized access port during surgical implantation. During implantation of theaccess port assembly10, a physician inserts thedelivery head96 into an incision that is somewhat offset from the implantation site, that is, the target location where the access port is attached.

Turning now as well toFIGS. 8A and 8B, thetool30 includes anactivation mechanism98.Activation mechanism98 enables automatic deployment of theattachment mechanism70, for example, by a physician using thesystem10 to attach theaccess port assembly10 to a patient.Activation mechanism98 will be described in greater detail elsewhere herein.

FIG. 9 shows a side view of thedelivery head96 of thetool30.Delivery head96 includes top100 andsidewall101. Whentool30 is coupled withaccess port assembly10, top100 extends over at least a portion ofaccess port34 and actuator cap58 (seeFIG. 5) andsidewall101 extends around and clips to at least a portion ofhousing sidewall56.

Turning back toFIGS. 8A and 8B, in this exemplary embodiment, theactivation mechanism98 comprises acable mechanism102 coupled to atrigger mechanism104.

Thecable mechanism102 comprises two opposinglymovable cables106 made of tungsten or similar material. Thecables106 extend from thetrigger mechanism104 along the tool handle90 to thedelivery head96 of thetool30.Trigger mechanism104 includes a manuallycompressible trigger104aand a trigger release button104b.

Generally, eachcable106 includes a substantially straight proximal portion extending along the handle of thetool30 and a curved distal portion connected to therotating element108 of the delivery head96 (seeFIG. 5). Suitable structure, for example,cable anchor107 is provided to securecables106 in place.Cables106 are movable in mutually opposing directions upon rotation ofwheel132.

In order to deploystaples74, an operator presses trigger104aas indicated inFIG. 8A. Compression oftrigger104 causes compression ofspring130, rotation ofwheel132 and longitudinal displacement ofcable106.Trigger latch134 is biased againstwheel132, for example by means of a spring (not shown). Oncetrigger104ais fully compressed as shown inFIG. 8B,trigger latch134 engageswheel132 atdetent notch132a(detent notch132 may be more clearly seen inFIG. 8A) and locks triggermechanism104. When trigger104ais fully compressed, trigger release button104bis “out” as shown inFIG. 8B. In order to causeanchors74 to retract, an operator presses trigger release button104b, which disengagestrigger latch134 fromdetent notch132aand load onspring130 causes reverse rotation of thewheel132.

Turning as well, briefly toFIGS. 5 and 6, longitudinal displacement ofcable106, activated by manually pressingtrigger104a, causes rotation ofrotating element108 and reciprocal rotation ofactuator cap58. Rotation ofactuator cap58 causes reciprocal rotation ofactuator element62 and deployment ofanchors74.

Rotation ofactuator element62 causes rotation of eachanchor74.

FIGS. 11,12 and13 illustrate deployment of ananchor74 from a retracted, undeployed, position, through a rotating, deploying, position, to an actuated position, respectively.

Referring now toFIGS. 5 and 10, the distal portion oftool30 is coupled to accessport assembly10 by insertingaccess port assembly10 betweensidewall101 ofdistal portion30. Whentool30 is engaged to accessport assembly10,protrusions112 ofrotating element108 are fixed in receivingports114 ofactuator cap58 andclips116 ofdistal portion sidewall101 engageundercuts118 ofhousing sidewall56.

Turning briefly toFIGS. 11,12 and13,access port assembly10 is shown in partial cross-sectional view, as it is being stapled or fixed to anabdominal muscle fascia120.

FIGS. 11-17 show different views of theaccess port assembly10 anddelivery head96 during anchor deployment.

More particularly,FIG. 11 showsattachment mechanism70 prior to deployment ofanchor74.

FIGS. 12,14 and16show delivery head96 andaccess port assembly10 during deployment ofanchor74. As shown in FIG.16, during deployment and prior to full deployment,clip116 ofdelivery head96 secures to undercut118 ofhousing sidewall56.

As shown inFIGS. 13,15, and17, when theactivation mechanism98 is fully deployed, structure, for example,berm142 ofrotating element108, forces clip116 outward and out of engagement with undercut118, thereby decouplingaccess port assembly10 from delivery heard96.

ExampleUse of the System

The following example describes one manner of using the presently shown and describedsystem20 of the invention to attach theaccess port assembly10 to a gastric banding patient.

Referring generally to the Figures, the physician threads thestrain relief element50 over soft tubing6 leaving about 2 cm of the tubing extending beyond locking end ofstrain relief element50.

The tubing is then coupled tobarb48 until flush withhousing sidewall56 ofport housing54. Thestrain relief element50 is then pushed into and locked ontocoupler51.

The physician checks that thetrigger mechanism104 is in a fully opened position such as shown inFIG. 7.

The physician inserts theaccess port assembly10 into thedelivery head96 of thetool30 by placing theaccess port assembly10 on a table with thesafety cap83 in contact with the table (FIG. 4), and pressingdelivery head96 againstaccess port assembly10 in a direction alongaxis52 ofFIG. 7. This causes theaccess port assembly10 to snap intodelivery head96. Thesafety cap83 is then manually removed from theaccess port assembly10. At this point, theanchors74 are positioned as shown inFIG. 11.

The physician places tubing from the gastric band into the abdomen. Theaccess port assembly10 is placed lateral to a trocar opening and a pocket is created for theaccess port assembly10 so that it is placed far enough from the trocar path to avoid abrupt kinking of the tubing. The tubing path is placed such that that the tubing will form a straight line with a gentle arching transition into the abdomen. The tubing is placed perpendicular to the midline of the patient.

The physician verifies that the fat has been fully cleared and the rectus muscle fascia is visible. Thedelivery head96 of thetool30 withaccess port assembly10 coupled thereto is placed into a dissected pocket in an angled position to facilitate insertion. Theaccess port assembly10 is place flat against the fascia to ensure that all anchors74 will fully engage the fascia and/or muscle tissue. The physician applies finger pressure to the top100 ofdelivery head96 to insure theaccess port assembly10 is flat against the fascia and thetool30 is steadied for firing.

The physician firmly squeezes thetrigger mechanism104 until it is fully closed thereby deploying theanchors74 into the underlying fascia. At this point, theactivation mechanism98 is locked in a closed position as shown inFIG. 8B and theanchors74 are fully deployed as shown inFIGS. 13,15 and17.

In order to disengage thetool30 from theaccess port assembly10, the physician slides thedelivery head96 away from theaccess port assembly10 for example, horizontally or laterally, and lifts thetool30 out of the incisional site. The physician ensures that theanchors74 are fully engaged into fascia by running a finger around the base of the access port assembly.

In the event theaccess port assembly10 is to be disengaged from the facia and repositioned, the trigger release button is pressed which unlocks the latch mechanism from the position shown inFIG. 8B which releases thetrigger mechanism104. Once the trigger is fully open the stainless steel anchors will be completed retracted back into theaccess port assembly10. Theaccess port assembly10 can then be redeployed usingtool30 as described hereinabove, in a different, for example, more desirable location.

Numerous benefits have been described which result from employing the concepts of the present invention. The foregoing description of one or more embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in light of the above teachings and are considered to be within the scope of the invention. The one or more embodiments were chosen and described in order to illustrate the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated.

Claims (17)

What is claimed is:

1. A system for attaching an access port to bodily tissue, the system comprising:

an access port assembly including:

i. an access port having a generally central axis and including a bottom, a sidewall and a needle penetrable septum; and

ii. an attachment mechanism structured to enable the access port to be attached to bodily tissue; and

a delivery tool including:

i. a delivery head structured to engage the access port assembly, the delivery head having a longitudinal sidewall extending parallel to the central axis when the delivery head engages the access port;

ii. a handle having a distal portion extending laterally away from the longitudinal sidewall of the delivery head and having a moveable trigger extending from a proximal portion of the handle, the handle defining an internal pathway in which a pair of opposingly movable cable portions extend side-by-side, the cable portions extending from the delivery head into the internal pathway of the handle, the cable portions being oppositely longitudinally moveable side-by-side relative to each other in the internal pathway and in the delivery head by movement of the trigger; and

iii. an activation mechanism coupled to the trigger for selectively enabling deployment and retraction of the attachment mechanism by movement of the trigger and a respective one of the cable portions when the delivery head is so engaged with the access port assembly.

2. The system ofclaim 1 wherein the handle extends away from the delivery head in a direction that does not intersect the generally central axis when the delivery head is so engaged with the access port assembly.

3. The system ofclaim 2 wherein the access port bottom is integral with the access port sidewall and the access port sidewall and access port bottom are a unitary configuration.

4. The system ofclaim 3 wherein the access port sidewall and access port bottom are titanium.

5. The system ofclaim 3 wherein the access port assembly further includes a housing including a housing sidewall surrounding the access port sidewall and an actuator assembly rotatable with respect to the housing sidewall.

6. The system ofclaim 1 wherein at least one of the cable portions includes tungsten.

7. The system ofclaim 1 wherein displacement of a respective one of the cable portions causes rotational movement of the attachment mechanism when the delivery head is engaged to the access port assembly.

8. The system ofclaim 1 wherein each of the cable portions has a substantially straight proximal portion and a curved distal portion.

9. The system ofclaim 1 wherein the attachment mechanism comprises at least one wire anchor.

10. The system ofclaim 9 wherein the wire anchor comprises a bent wire having a multi-faceted tip.

11. The system ofclaim 1 wherein the attachment mechanism comprises at least one anchor having a curved distal portion and a pivotal proximal portion substantially perpendicular with the curved distal portion.

12. The system ofclaim 1 wherein the attachment mechanism comprises at least one anchor having a spiral distal portion and a straight proximal portion substantially perpendicular with the spiral distal portion.

13. The tool ofclaim 1 wherein each of the cable portions has a substantially straight proximal portion and a curved distal portion.

14. The system ofclaim 1 wherein the delivery head has a substantially flat top surface and a substantially curved side surface, further wherein the handle is attached to the curved side surface of the delivery head.

15. A delivery tool for attaching an access port assembly to bodily tissue, the access port assembly including deployable fasteners and an access port having a generally central axis, the tool comprising:

a delivery head structured to engage the access port assembly, the delivery head having a longitudinal sidewall extending parallel to the central axis when the delivery head engages the access port;

a handle having a distal portion extending laterally away from the longitudinal sidewall of the delivery head and having a moveable trigger extending from a proximal portion of the handle, the handle defining an internal curved pathway in which a pair of opposingly movable cable portions extend side-by-side, the cable portions extending from the delivery head into the internal pathway of the handle, the cable portions being oppositely longitudinally displaceable side-by-side relative to each other by movement of the trigger; and

an activation mechanism coupled to the trigger for selectively enabling deployment and retraction of the deployable fasteners by movement of the trigger and a respective one of the cable portions when the delivery head is so engaged with the access port assembly,

wherein movement of the trigger is constructed to longitudinally displace a respective one of the cable portions in the internal pathway of the handle and in the delivery head to rotate a rotatable portion of the access port assembly when the delivery head is engaged to the access port assembly to move the deployable fasteners relative to the access port assembly, and

wherein each of the cable portions has a substantially straight proximal portion and a curved distal portion.

16. The tool ofclaim 15 wherein at least one of the cable portions includes tungsten.

17. The tool ofclaim 15 wherein the delivery head has a substantially flat top surface and a substantially curved side surface, further wherein the handle is attached to the curved side surface of the delivery head.

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